The incidences of acute mesenteric ischaemia vary greatly depending on the population and diagnostic activity

Excerpt

We much appreciate the interest of Drs Gazelli and Nacher regarding the AMESI study [1, 2], and for their effort to debate the difficulties in establishing a “true incidence” of acute mesenteric ischaemia (AMI) [3]. To address the question of true incidence, we first need to acknowledge the multifaceted nature of AMI. The main drivers of arterial occlusive AMI are cardiac arrhythmias (that increase exponentially with age) explaining most embolic occlusions, and smoking, which is the most important risk factor for thrombotic occlusion [4‐6]. The non-occlusive arterial AMI (NOMI) is mainly associated with intensive care practices, as well as the incidences of sepsis and heart surgery [1, 6]. The main risk factors for venous AMI are obesity, previous venous thromboembolism and genetic thrombophilia [1, 6, 7]. Given this complex pathophysiological background, it is not surprising that the crude incidence rates vary depending on the studied population [8]. Those risk factors, as well as demography, likely vary greatly between regions, countries and hospitals across the world. The estimated incidence of AMI and its subtypes is unknown in most countries, except in Estonia, Sweden, and Finland, where population-based studies have recently been conducted, the latter two also declaring autopsy rates in their respective populations [9‐11]. As the authors rightly imply, we lack the detailed knowledge on the incidence of the different entities of AMI in low–middle-income countries. A parallel may be drawn with the cardiovascular disease with largely variable incidences and trends between countries, where the burden in high-income countries may decline, while increasing in low–middle-income countries [12, 13], perhaps with increasing incidence of AMI. …